Action: Oct. 14, 2016

TMA Action Oct. 14, 2016   News and Insights from Texas Medical Association

ICD-10 Update Creates Problems for PQRS Reporting, Value Modifier
Houston Judge Changes Course, Says DOs Can File Commitment Papers
TMA Supports JUA's Ability to Write New Business
Be in the Know When You Purchase an EHR
Half of All U.S. Physicians Say They Are Burned Out
TMF Launches Quality Payment Program Network
What Happened to 2017's Half-Percent Medicare Fee Hike?

Register Now for the Texas Quality Summit
Looking for an Excuse to Walk? Join the Step It Up! Challenge
Nominate a Gifted Texas Science Teacher Who Deserves Recognition
Yes, This Campaign Season is Almost Over
Last Chance to Win $5,000 for Your Champion of Health
This Month in Texas Medicine

ICD-10 Update Creates Problems for PQRS Reporting, Value Modifier

As if physicians don't have enough headaches and hassles to deal with to keep their practice doors open, the latest news from the American Medical Association is not good. It turns out the Oct. 1 ICD-10 update will negatively affect some physicians who participate in quality reporting for the Centers for Medicare & Medicaid Services (CMS) Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier (VM) programs. To determine whether the update affects your specialty, review the list of affected quality measures.

Despite the recent ICD-10 update, specifications for all quality measures remain the same. Due to the timing in finalizing codes for the update and the number of codes involved, CMS did not update the measure specifications to include the coding changes, thereby creating problems for the PQRS and VM programs. This issue may lead to confusion for many physicians and groups, resulting in incorrect coding and failed reporting for the 2016 PQRS program year and payment penalties under both programs in 2018.

AMA reports it is working with CMS to resolve the issue and reports "the agency has assured the AMA that every effort will be made to prevent physicians from being penalized for issues resulting from the ICD-10 coding update." TMA will actively track this issue and will keep members informed as the association learns more. 

For more information, read this AMA article. And for guidance on quality reporting for the 2016 program year, visit the TMA PQRS and VM Resource Center

Houston Judge Changes Course, Says DOs Can File Commitment Papers

Physicians across Texas are breathing a sigh of relief — at least for now — thanks to Harris County Probate Judge Rory Olsen's decision to allow doctors of osteopathy (DOs) to file Certificates of Medical Examinations needed for mental health commitments. TMA and a host of other physician organizations have been fighting the judge's initial ruling, which prohibited DOs from signing the commitment papers.

Responding to a request from a leading Houston psychiatrist who is also a DO, TMA's legal staff initially contacted Judge Olsen via telephone. TMA, the Harris County Medical Society, Texas Osteopathic Medical Association, the Federation of Texas Psychiatry, and the American Osteopathic Association (AOA) then wrote a joint letter to Judge Olsen explaining the legal equivalence in Texas of allopathic and osteopathic physicians. "Eliminating DOs' authority in the most populous county in Texas could have disastrous consequences for the health and safety of persons who physicians have determined need protective psychiatric care," they wrote.

Lawyers for the AOA and the Texas Medical Board also sent Judge Olsen detailed legal briefs on the issue.

The judge's controversial decision prompted Senate Health and Human Services Committee Chairman Charles Schwertner, MD (R-Georgetown), to take action. "As a physician, I find Judge Olsen's attempt to singlehandedly redefine the practice of medicine both reckless and profoundly misguided," he said as he asked Attorney General Ken Paxton to issue a formal opinion to affirm that MDs and DOs enjoy the same legal rights. 

The next day, Judge Olsen announced he would accept commitment requests signed by DOs, pending a decision from General Paxton. "Judge Olsen made the correct decision," said TMA President Don Read, MD. "Physicians and the patients we serve appreciate the intervention of Senator Schwertner and are confident General Paxton also will reach the correct decision."

"The simple fact is, Judge Olsen doesn't have the authority to decide which physicians he does or does not want to listen to," Senator Schwertner said. "Regardless of this man's opinion, the law governing the practice of medicine is exceedingly clear: DOs — just like MDs — are fully-trained, licensed, and accredited physicians with all the rights and responsibilities that entails. Period."

TMA Supports JUA's Ability to Write New Business

On Oct. 5, TMA sent a letter urging Texas Department of Insurance (TDI) Commissioner David Mattax to prevent the Texas Medical Liability Insurance Underwriting Association (JUA) from suspending the writing of new business. The JUA, established in 1975, is "critically important as a last stop gap to assure that licensed physicians and health care providers are able to continue to provide medical and dental care for their Texas patients," TMA wrote.

In the letter, TMA General Counsel Rocky Wilcox argues that the state's rapidly growing physician workforce, economic uncertainty, and regular cycles in the liability climate all demand that the JUA remain open as the insurer of last resort. "Physicians are not able to contract with a network or have privileges in a hospital without medical professional liability coverage," Mr. Wilcox wrote. "Therefore, they would not be able to effectively practice medicine." 

Commissioner Mattax is conducting a hearing on the question Oct. 17. The issue arises due to a law passed last year, which TMA supported, that would use some of the JUA's reserves to finance a permanent trust fund for graduate medical education programs.

The 1975 legislation that created the JUA "enacted the right of associations such as TMA to sponsor self-insured trusts as another means of solving the insurance availability and affordability problems" of physicians at the time. Under the law, TMA sponsored the creation of Texas Medical Liability Trust, which provides coverage to qualified TMA members.  

The letter asserts TMA's strong belief that the JUA is "still necessary and its authority to write new business should not be suspended." TMA writes that uncertainty in the medical professional liability insurance market, the worldwide market, medical professional liability court decisions, the political and economic environment, and the tort legal environment could affect physicians and could "cause some insurers to be more restrictive in underwriting."   

TMA says few liability insurers offer occurrence or claims-made policies, which the JUA provides. "Occurrence policies are an attractive alternative to some physicians in some specialties where there is a 'long-tail' on claims, such as pediatricians, obstetricians, and other providers treating young children."

TMA's letter concludes by requesting TDI "find that a necessity still exists for the JUA to be able to continue to write new business."

Action TMLT Ad 10.15 

Be in the Know When You Purchase an EHR

The recently updated TMA EHR Vendor Comparison Tool provides TMA member physicians access to an assessment of EHR products that have a solid Texas market base. It gives physicians a view of company information, product functionality, pricing, and interoperability capabilities when comparing EHR systems.

The revised tool reflects current information from some of the top vendors in Texas. The top nine vendors, which have at least a 3-percent market-share in Texas, were asked to participate. Not all of them chose to submit their information.

As physicians review demonstrations and hear about the latest and greatest from EHR salespeople, remember it is the contract that seals the deal and defines the future relationship. TMA cannot stress enough the importance of a good contract review. Seek the guidance of your attorney or one who is savvy with EHR contracts. 

Paying for a contract review may be worthwhile because:  

  • There may be hidden fees not disclosed during the negotiations but spelled out in the contract;
  • You need an exit strategy in case the relationship sours beyond repair; and
  • The contract should include terms defining how you obtain your data should you sever the relationship. 

With these issues in mind, TMA developed a helpful tool, EHR Buyer Beware: Issues to Consider When Contracting with EHR Vendors, an eight-page document featuring eight must-haves for physicians. The Office of the National Coordinator for Health Information Technology recently made available another source, EHR Contracts Untangled: Selecting Wisely, Negotiating Terms, and Understanding the Fine Print. The 53-page document is more inclusive and covers information such as details about data rights and switching EHRs.

You can direct questions related to EHRs and other office technologies to TMA's Health Information Technology Department by calling (800) 880-5720 or by emailing hit[at]texmed[dot]org.

Half of All U.S. Physicians Say They Are Burned Out

U.S. physicians love their patients and hate paperwork. Unfortunately, a newly released survey by The Physicians Foundation finds that the paperwork is winning. Fifty-four percent of physicians surveyed say their morale is somewhat or very negative, and 49 percent say they either often or always feel burned out. 

As a result, 48 percent plan to cut back on hours, retire, take a nonclinical job, switch to concierge medicine, or take other steps that will further limit patients' access to care. These patterns are likely to reduce the physician workforce by tens of thousands at the time that a growing, aging, and more widely-insured population is increasing overall demand for physicians.

Regulatory/paperwork burdens and loss of clinical autonomy are the primary sources of physician dissatisfaction. More than two-thirds (72 percent) say these third-party intrusions detract from the quality of care they can provide. 

 — Check out these TMA courses to help you recognize and counteract burnout and stress —

According to the research, 80 percent of physicians report being overextended or at capacity, with no time to see additional patients. This remains steady with the findings reported in the 2014 survey from the Physicians Foundation. Not surprisingly, 54 percent of physicians surveyed rate their morale as somewhat or very negative.

"Many physicians are dissatisfied with the current state of medical practice and are starting to opt out of traditional patient care roles," said Walker Ray, MD, president of the Physicians Foundation and chair of its Research Committee. "By retiring, taking non-clinical roles, or cutting back in various other ways, physicians are essentially voting with their feet and leaving the clinical workforce. This trend is to the detriment of patient access. It is imperative that all health care stakeholders recognize and begin to address these issues more proactively, to support physicians and enhance the medical practice environment."

TMF Launches Quality Payment Program Network

The TMF Quality Innovation Network Quality Improvement Organization (QIN-QIO) has created a new network to help physicians and clinicians make the transition under the Medicare Access and CHIP Reauthorization Act (MACRA) to participate in Medicare's new Quality Payment Program and its Merit-Based Incentive Payment System (MIPS). To learn more and create a free account, visit the TMF Quality Payment Program web page.

Additionally, the TMF QIN-QIO is hosting upcoming online events for the benefit of physicians, hospitals, and other health care professionals. Mark your calendars, and plan to attend. 

Oct. 25 Webinar: How to Prepare for MIPS

Register to attend this TMF Quality Innovation Network webinar to learn how to prepare for a paradigm shift in quality reporting and payment programs. The highly anticipated proposed rule implementing MACRA on Jan. 1, 2017, is fast approaching. Participate in a webinar to receive valuable information from Selena Hood, program manager of quality measures and reporting with McKesson, to help you and your practice prepare to make the successful transition to participate in MIPS. This event will take place Tuesday, Oct. 25, from noon to 1 pm (CT). Register today. 

Oct. 26 Open Forum: 2016 Meaningful Use and PQRS

Join this TMF Quality Innovation Network open forum event to learn about upcoming changes related to meaningful use and the Physician Quality Reporting System. You will have the opportunity to ask questions and interact with peers, as well as TMF Quality Innovation Network consultants. This open forum will take place Wednesday, Oct. 26, from noon to 1 pm (CT). Register today.

Save the date for the Nov. 16 Open Forum. Visit, and click on the Events tab for more information. 

What Happened to 2017's Half-Percent Medicare Fee Hike?

Zero. That's how much physicians' overall Medicare fees will go up next year, according to the Centers for Medicare & Medicaid Services' (CMS') complex rule on the 2017 proposed Medicare Physician Fee Schedule.

What happened, the Harris County Medical Society's Board on Socioeconomics wants to know, to the 0.5-percent Medicare payment increase physicians were supposed to see thanks to the passage of the bill last year that eliminated Medicare's Sustainable Growth Rate (SGR) formula?

Well, as they say, "it's complicated."

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which erased the SGR, did indeed include what CMS calls a 0.5-percent "positive update" for physicians every year from 2016 through 2018. Physicians, however, didn't see a positive update this year for the same reason they probably won't get one in 2017, and may not get one in 2018, explains Donna Kinney, TMA's director of research and data analysis.

The disappearing updates all stem from another piece of federal legislation passed in 2014 that requires CMS to set an annual target for reduced Medicare spending on physicians' services "resulting from adjustments to relative values of misvalued codes." That target for 2017 is a 0.5-percent reduction. (Depending on the specific services they provide and which codes they use, individual physicians will see larger or smaller changes in their payments, Ms. Kinney emphasizes.) The bottom line is, however, the adjustment for the "misvalued codes" exactly counteracts the 0.5-percent increase coming from MACRA.

"The recent history of and future plans for inadequate fee updates, paired with the growing Medicare administrative burden, is making Medicare participation and compliance increasing difficult and costly for practicing physicians, and will impair access to care for Medicare beneficiaries," John Carlo, MD, of Dallas, chair of TMA's Council on Socioeconomics, wrote in the association's formal comment letter to CMS on the 2017 proposed Medicare Physician Fee Schedule. "Increases in administrative complexity are making Medicare participation an increasingly unattractive proposition to the smaller sized practices common in Texas."

By the way, that 2014 bill — the Protecting Access to Medicare Act of 2014 — wasn't all bad news for physicians, Ms. Kinney says. The most important provision of that bill canceled a 23.7-percent, across-the-board cut in physicians' Medicare payments that had been required due to the SGR.

   TMAIT Action Ad 6.15

Register Now for the Texas Quality Summit

This fall, TMA is hosting a unique event to help you improve performance, increase efficiency, and continue to deliver high-quality care. Join your colleagues for the Texas Quality Summit Nov. 18–19, and get the latest resources and hands-on training to take your practice to the next level. Register now, as seating is limited.

The Texas Quality Summit, cohosted by the TMA Council on Health Care Quality and the American College of Medical Quality (ACMQ), begins with a powerful pre-conference workshop, ACMQ's Quality Improvement and Patient Safety Workshop, on Friday, Nov. 18. Next, attend the full-day summit on Saturday, Nov. 19, for in-depth presentations, physician panels, and case studies addressing quality strategies to enhance your practice. Programming will include an update on health population trends in Texas, transitioning to value-based care, alternative payment models, implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), and much more. 

Continuing medical education credit is available. On Nov. 18, you can earn up to 5.25 AMA PRA Category 1 Credits™ in ethics and/or professional responsibility. On Nov. 19, you can earn up to 7.25 AMA PRA Category 1 Credits™ in ethics and/or professional responsibility.

The 2016 Texas Quality Summit will be held in Austin at the TMA building in the Thompson Auditorium. Discounted room rates are available to attendees at the Doubletree, conveniently located across the street from the TMA building. 

 Space is limited, so register online today. For more information, visit the TMA website or read "Learn From the Experts" in the October issue of Texas Medicine

Looking for an Excuse to Walk? Join the Step It Up! Challenge

As promised, U.S. Surgeon General Vivek Murthy, MD, released a nationwide, two week-long challenge to promote walking. The challenge began on Thursday, Oct. 13.

TMA wants you and your patients to participate. Join the Walk With a Doc Texas team, and help us get Texans moving. It's easy and free. Follow these two simple steps: 1) join our team, and 2) record your steps online.

Promote the competition, and encourage people to track their steps. Use social media, and tag TMA (@texmed), Walk With a Doc (#wwadtx or #justwalk), and the surgeon general (#StepItUp). Let's show the U.S. Surgeon General and the rest of America how active Texans really are.

The challenge runs from Oct. 13–26, so sign up today, and spread the word. For more information, contact Debra Heater at (800) 880-1300, ext. 1390 or by email at debra.heater[at]texmed[dot]org.  Visit the TMA website for more details.

Nominate a Gifted Texas Science Teacher Who Deserves Recognition

TMA is giving away $24,000 in cash prizes. Help spread the word. Three Texas science teachers will receive $5,000 each and an all-expense paid trip to TexMed 2017 in Houston for the award ceremony. Their schools will receive a $2,000 award to use for the science curriculum. Second-place winners receive $1,500 and another $1,000 for their schools.

Each year, TMA's Ernest and Sarah Butler Awards for Excellence in Science Teaching recognize and reward schoolteachers at the elementary, middle, and high school levels who share their energy and enthusiasm for science with their students. TMA does this because innovative teaching supports the basic premise of medicine: Health care has a scientific foundation.

All Texas state-certified, full-time public and private school science teachers with a minimum of two years of completed classroom experience who will return to teach during the 2017–18 school year are eligible. Teachers specializing in all areas of science are eligible.

To nominate science teachers or to apply, visit the TMA website, where you will find more information and the appropriate forms. Deadlines are Nov. 18 for nominations and Dec. 16 for applications. (All nominees will be contacted by TMA and asked to complete an application.) 

Help TMA ensure Texas science teachers are well-represented. If you'd like to provide support for the Ernest and Sarah Butler Awards for Excellence in Science Teaching, visit the TMA Foundation donor page.

For more information, email Gail Schatte at TMA, or call (800) 880-1300, 1600, or (512) 370-1600.

PC Action Ad June 13

Yes, This Campaign Season is Almost Over

Almost lost in the interminable slog through the mud of the 2016 presidential campaign are the critically important races for key Texas courts and the state Senate and House of Representatives. Luckily, TEXPAC and engaged local physicians around the state have kept their fingers on those races and prepared a strong slate of endorsed candidates to recommend to TMA members.

Election day is Nov. 8, but early voting runs from Monday, Oct. 24, through Friday, Nov. 4. Check with your county clerk's office for a list of early voting times and locations.

"As a political junkie, I have … unfortunately … watched the ugly national campaign closely, and right now I sure am glad that TEXPAC doesn't make endorsements in presidential races," said Waco otolaryngologist Brad Holland, MD, chair of the TEXPAC Board of Directors. "But we have followed the recommendations of practicing physicians across Texas to put together an outstanding list of judicial and legislative incumbents and challengers who we believe medicine should support."

That list includes incumbent Texas Supreme Court Justices Eva Guzman (Place 9) and Paul Green (Place 5), who are running statewide.

Many of these down-ballot races are looking to be quite close, Dr. Holland said, so "it is absolutely crucial" for physicians to turn out and vote in these contests.

TEXPAC encourages TMA and TMA Alliance members to: 

  1. Make note of the endorsed candidates running in your precinct;
  2. Share the list with your colleagues, friends, family members, and patients; and
  3. Make plans to vote early and avoid the long lines on election day. 

TEXPAC is TMA's bipartisan political arm, helping to elect medicine-friendly candidates at the local, state, and federal levels. Created in 1962, TEXPAC is one of the oldest political action committees in Texas. With more than 4,500 member physicians, medical students and spouses, TEXPAC works to advance TMA's mission of improving the health of all Texans and enables TMA members to protect Texas patients through political education and activism.

Last Chance to Win $5,000 for Your Champion of Health

You have until Oct. 31 to nominate a program in your town or city that promotes healthy lives and healthy communities for a $5,000 grant. The 2017 John P. McGovern Champion of Health Award focuses on exceptional projects that address urgent threats to the public's health and those that further TMA Foundation's mission: to help physicians create a healthier future for all Texans.

Established in 1995, the award has recognized local and statewide programs for their innovative and effective ways of reaching Texans. It is named after John P. McGovern, MD, a philanthropist and humanitarian who founded the John P. McGovern Foundation in Houston. Dr. McGovern established a permanent endowment at TMAF that supports this award. 

Winners are notified in December, and the award will be presented on Jan. 28, 2017, at the TMA Winter Conference at the Hyatt Regency Austin. Download the nomination form, and view a list of past winners. Contact TMAF at (800) 880-1300, ext. 1664, or (512) 370-1664 for more information about the program.

This Month in Texas Medicine

The October issue of Texas Medicine features a cover story on complementary and alternative medicine; TMA policy recommends physicians stay on top of evidence-based studies of complementary and alternative therapies and routinely ask patients about their use of such therapies. In the issue you'll also find coverage of five steps physicians can take right now to prepare for the transition to the new Medicare payment system; TMA's Hard Hats for Little Heads program, which has given away more than 235,000 helmets to Texas children in the past 22 years; a negligence lawsuit with broad legal implications; and the Texas Quality Summit, hosted by TMA and the American College of Medical Quality.

Check out our digital edition

Texas Medicine RSS Feed

Don't want to wait for Texas Medicine to land in your mailbox? You can access it as an RSS feed, the same way you get the TMA Practice E-Tips RSS feed. 

E-Tips RSS Feed

TMA Practice E-Tips, a valuable source of hands-on, use-it-now advice on coding, billing, payment, HIPAA compliance, office policies and procedures, and practice marketing, is available as an RSS feed on the TMA website. Once there, you can download an RSS reader, such as Feedreader, Sharpreader, Sage, or NetNewsWire Lite. You also can subscribe to the RSS feeds for TMA news releases and for Blogged Arteries, the feed for Action.  


This Just In ...

Want the latest and hottest news from TMA in a hurry? Then log on to Blogged Arteries.  

TMA Education Center

The TMA Education Center offers convenient, one-stop access to the continuing medical education Texas physicians need. TMA's practice management, cancer, and physician health courses are now easier than ever to find online.  


Medicare and MACRA: Get Clarity and Direction!
Medical Records: Most Wanted Answers  
Straight From a Lawyer's Mouth: Answers to Your Legal Questions  

Conferences and Events

2016 TMA Advocacy Retreat
Dec. 2-3
Omni Barton Creek Resort

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Last Updated On

December 05, 2016